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Individual
GARY D. WALTERS
Active
Individual
GARY D. WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
11913
CA
363L00000X
Nurse Practitioner
Primary
11913
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11913
NP LICENSE
CA
Enumeration date
08/07/2007
Last updated
08/07/2007
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